Suzuki Student Registration

Please fill out one form for each child you are registering. After you have succesfully submitted the form, a confirmation page will appear with instructions on how to complete your registration.

Suzuki Student Registration

Student Name *

First

Last

Gender *

Male Female

Student Age (on July 1, 2012) *

Instrument *

Current Suzuki Book *

Current Working Piece *

Course I am registering for *

Registration Fee (per family). Determined by date you submit this application *

Parent Name *

First

Last

Other parent/chaperone attending the Institute *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Emergency Contact Phone Number *

Parent Email *

Teacher Name *

Teacher Email *

My child plans to perform on a student recital *

My child will require a piano accompanist for his/her solo piece *

Estimated Recital Piece (please include Suzuki Book if applicable) *

1st choice Elective *

2nd choice Elective *

Please see Electives Page for descriptions

Would you like to order an Institute T-Shirt ($15)? All proceeds will go towards our Institute Scholarship fund.

T-Shirt- 100% Cotton T *

Yes please! No, thank you

Please click here for the T-Shirt Sizing Guide

T-Shirt Size *

I would like to order cafeteria lunches for the week ($30/week/per person) *

I give the Institute photographer permission to take photographs of my child for the Institute website. *

By registering my child, I acknowledge as legal parent/guardian that I am solely responsible for my child during Institute and that I must accompany and supervise my child at all times on the Milton Hershey Campus. If I cannot be present, I will arrange for a trustworthy family member or friend to accompany and supervise my child at all times. I understand that the Pennsylvania Suzuki Institute, the Milton Hershey School and all staff and faculty members are not held liable in any way for the care of my child, or our personal belongings.

Please type your initials below if you agree to the above statement. *

Questions, Comments *

How did you hear about us? *

Submit

If all required fields are not completed, the form will not submit and the Registration Form will refresh with a red box around incomplete items. A confirmation page will appear if you have submitted all of the information successfully. If you have technical problems, please contact us at PennsylvaniaSuzukiInstitute@gmail.com